Regional Workshop to Use the Findings from Operations Research

Regional Workshop to Use the Findings from Operations Research to Increase the Access, Quality and Integration of Contraceptive Services in Latin America and the Caribbean Frontiers in Reproductive Health (FRONTIERS), Population Council M. Estela Rivero-Fuentes Antonieta Martin April 2008 This study was possible through the generous support of the people of the United States through the United States Agency for International Development (USAID), under the terms of Cooperative Agreement No. HRNA-00-98-00012-00 and In-house project 5800 53117. The contents are the responsibility of the FRONTIERS Program and do not necessarily reflect the points of view of USAID or the United States Government. EXECUTIVE SUMMARY In October 2007, the Frontiers in Reproductive Health Program (FRONTIERS) held a three-day regional workshop in La Antigua, Guatemala, to disseminate results of its operations research projects. The workshop was attended by 60 participants from 11 countries: Bolivia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Peru and the United States. Participants included health providers, program managers, non- governmental organization (NGO) directors, bilateral-agreements country representatives, and directors of professional organizations, the list of participants was composed of delegates from Ministries of Health (MOH), Social Security Institutes (SSI), USAID missions, international agencies, and non-governmental organizations (NGOs). During the workshop, participants received contraceptive technology updates, and learned about effective strategies tested by FRONTIERS to increase access to the IUD and vasectomy, integration of family planning with postpartum, postabortion and PMTCT. Featured were the Balanced Counseling Strategy (BCS), and Systematic Screening. Researchers discussed study results; program managers explained how they were used, and practitioners talked about implementing the interventions. This combination of perspectives successfully transmitted the message that the interventions were not difficult to apply, could have a great impact, and, as one participant wrote on the evaluation form, that “small changes could lead to great results”. Workshop participants also received materials developed by FRONTIERS and other institutions to help integration efforts. The materials distributed included: a) Three CDs. The first was prepared specially for the meeting, containing all the Spanish- language versions of FRONTIERS final reports, operations research summaries, manuals, and job-aids, as well as WHO’s medical eligibility criteria for contraceptive use (MEC). The CD also included a compilation of scientific articles and job-aids on postpartum contraception; and the IUD toolkit. The second CD was “Improving Reproductive Health Services. FRONTIERS Operations Research. 1998-2005,” and the third, the “Frontiers in Reproductive Health Electronic Library 1990-1999.” b) The Spanish translation of Family Health International’s (FHI) “Frequently Asked Questions on Contraception.” c) The Spanish version of the systematic screening manual and examples of the algorithm used in Latin American countries. d) The Spanish version of the Balanced Counseling Strategy including cards, brochures and algorithm. Participants prepared plans to put lessons learned at the workshop into practice. Seven countries prepared action plans (Bolivia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras and Nicaragua). Others proposed organizing an informal electronic forum to continue discussing the topics covered at the workshop. Four countries said they would attempt to adapt the BCS or the systematic screening technique to their local context, and three proposed to i strengthen the integration of family planning and prevention of mother to child transmission of HIV services. The final workshop evaluations, returned by 23 participants, showed that they found the workshop very useful for their work. When asked what they liked the most, 57% mentioned the balanced counseling strategy and 52% mentioned the exchange of experiences. After the workshop ended, Population Council created an URL that displays the workshop presentations and all the materials distributed. ii TABLE OF CONTENTS EXECUTIVE SUMMARY ............................................................................................................. i INTRODUCTION ...........................................................................................................................1 OBJECTIVES ..................................................................................................................................1 AGENDA AND WORKSHOP ACTIVITIES.................................................................................1 PARTICIPANTS .............................................................................................................................2 MESSAGES EMPHASIZED DURING THE WORKSHOP..........................................................2 PARTICIPANTS’ FEEDBACK ......................................................................................................3 Lessons learned ........................................................................................................................... 4 PERCEIVED OBSTACLES TO THE IMPLEMENTATION OF THE STRATEGIES AND INTERVENTIONS DISCUSSED .....................................................................................5 PLANS TO IMPLEMENT LESSONS LEARNED AT THE WORKSHOP ..................................6 APPENDIX 1: FRONTIERS PROJECTS REFERRED TO DURING THE WORKSHOP, BY COUNTRY OF IMPLEMENTATION ................................................................................8 APPENDIX 2: WORKSHOP AGENDA ....................................................................................9 APPENDIX 3. LIST OF PARTICIPANTS ...................................................................................13 APPENDIX 4: FEEDBACK QUESTIONNAIRES AND WORKING GROUP GUIDELINES ..........................................................................................................................17 LIST OF TABLES TABLE 1: TOP-THREE TOPICS PERCEIVED AS THE MOST USEFUL, BY WORKSHOP DAY .....................................................................................................................4 TABLE 2: MOST IMPORTANT LESSONS FROM COUNTRY GROUP WORK SESSIONS...................................................................................................................................6 iii INTRODUCTION In Latin America, the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program, funded by USAID, continued to support a program of operations research initiated by the Investigación Operativa en Planificación Familiar y Atención Materno-Infantil para América Latina y el Caribe (INOPAL) I, II and III programs, all of which had been funded by USAID and implemented by the Population Council between 1984 and 1998. The strategies and results presented during the workshop drew primarily from FRONTIERS and INOPAL projects in the region, but relevant results from Sub-Saharan Africa and Asia and the Middle East were also presented. Altogether, the presentations summarized 23 FRONTIERS projects (see Appendix 1) and the subsequent experience of program managers, and health providers in scaling-up and making the interventions sustainable. The workshop emphasized integration of family planning with other health services and the need for systematic screening as an entry point for identifying and meeting various FP/RH needs. Presentations were also made about strategies to integrate family planning and postpartum, postabortion, and PMTCT services. Strategies for the introduction of vasectomy, the Balanced Counseling Strategy, and increasing IUD use were also discussed. OBJECTIVES To contribute to the strengthening of family planning programs in the region through the communication of lessons learned and materials developed. To raise awareness of FRONTIERS-supported projects in the design, testing and implementation of innovative strategies. To give an overview of contraceptive methods available in the region, review WHO eligibility criteria, and the status of family planning programs. AGENDA AND WORKSHOP ACTIVITIES On the first day, participants heard about the current situation of family planning programs in Latin America and the Caribbean, strategies to increase access to the IUD in Guatemala and Honduras, and the introduction of no-scalpel vasectomy, in public hospitals in Guatemala. The second day covered minilaparotomy, emergency contraception, natural family planning and strategies for integrating family planning and postpartum, postabortion and PMTCT services. During the third day, participants listened to presentations on Systematic Screening and the Balanced Counseling Strategy, followed by break-out groups in which they learned how to apply the techniques. Before the workshop’s closing ceremony, groups of participants from the same country identified the themes and lessons that were most useful for them, and each suggested three concrete actions they would take to implement lessons learned into practice. The workshop agenda is included as Appendix 2. 1 PARTICIPANTS A total of 60 individuals from reproductive health organizations in Latin America and the Caribbean participated in the workshop. USAID missions and Ministries of Health in Bolivia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Nicaragua

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